Levodopa pharmacotherapy for cocaine dependence: Choosing the optimal behavioral therapy platform

Joy M. Schmitz, Marc E Mooney, F. Gerard Moeller, Angela L. Stotts, Charles Green, John Grabowski

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background: The dopamine precursor levodopa has shown some, albeit relatively weak, promise in treating cocaine dependence. This study sought to identify the most appropriate behavioral therapy platform for levodopa pharmacotherapy by evaluating its effect when administered in combination with behavioral platforms of varying intensities. Method: A total of 161 treatment-seeking cocaine dependent subjects received sustained release levodopa/carbidopa (400/100 mg bid, Sinemet) or placebo delivered in combination with Clinical Management (ClinMan); ClinMan + cognitive behavioral therapy (CBT); or ClinMan + CBT + voucher-based reinforcement therapy (VBRT) in a 12-week randomized, placebo-controlled, double-blind (for medication condition) trial. Medication compliance was monitored with riboflavin (100 mg/capsule) and the Medication Event Monitoring System. Protocol compliance was addressed in weekly, 10-min nurse-delivered ClinMan sessions. Weekly, 1-h CBT sessions focused on coping skills training. VBRT (with escalating reinforcer value) provided cash-valued vouchers contingent on cocaine-negative urine toxicology results. Urine benzoylecgonine assays collected thrice-weekly were analyzed by intention-to-treat criteria using generalized linear mixed models. Results: Levodopa main effects were found on all outcome measures of cocaine use. Contrasts testing the levodopa-placebo difference within each behavioral platform found reliable effects, favoring levodopa, only in the VBRT platform. Levodopa treatment with vouchers produced higher proportions of cocaine-negative urines and longer periods of consecutive abstinence compared to other treatment combinations. Conclusion: This is the first study to find a significant treatment effect for levodopa and, in doing so, to demonstrate that the magnitude of this effect is dependent upon conditions of the behavioral therapy platform. The data support use of levodopa with abstinence-based reinforcement therapy as one efficacious combination in cocaine dependence disorder treatment.

Original languageEnglish (US)
Pages (from-to)142-150
Number of pages9
JournalDrug and alcohol dependence
Volume94
Issue number1-3
DOIs
StatePublished - Apr 1 2008

Fingerprint

Drug therapy
Cocaine-Related Disorders
Levodopa
Cocaine
Drug Therapy
Reinforcement
Cognitive Therapy
Therapeutics
Placebos
Urine
Riboflavin
Guideline Adherence
Capsules
Medication Adherence
Assays
Dopamine
Psychological Adaptation
Toxicology
Linear Models
Monitoring

Keywords

  • Cocaine treatment
  • Contingency management
  • Levodopa-carbidopa
  • VBRT
  • Voucher-based reinforcement therapy

Cite this

Levodopa pharmacotherapy for cocaine dependence : Choosing the optimal behavioral therapy platform. / Schmitz, Joy M.; Mooney, Marc E; Moeller, F. Gerard; Stotts, Angela L.; Green, Charles; Grabowski, John.

In: Drug and alcohol dependence, Vol. 94, No. 1-3, 01.04.2008, p. 142-150.

Research output: Contribution to journalArticle

Schmitz, Joy M. ; Mooney, Marc E ; Moeller, F. Gerard ; Stotts, Angela L. ; Green, Charles ; Grabowski, John. / Levodopa pharmacotherapy for cocaine dependence : Choosing the optimal behavioral therapy platform. In: Drug and alcohol dependence. 2008 ; Vol. 94, No. 1-3. pp. 142-150.
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